Hepatitis
Hepatitis is not one illness but a general word for inflammation of the liver. The causes differ: five viruses named after letters, alcohol, medicines and…
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Hepatitis is not one illness but a general word for inflammation of the liver. The causes differ: five viruses named after letters, alcohol, medicines and supplements, and the immune system itself. The course differs too, from an infection that passes in a couple of weeks without a trace to a quiet process lasting years and ending in cirrhosis. Telling them apart matters for a simple reason: some are cured, some have a vaccine, and some call not for tablets but for a change of habits.
How an inflamed liver behaves
Acute inflammation often slips by unnoticed, especially in children. When complaints do appear, they look much the same whatever the cause:
- weakness and the feeling of coming down with something;
- fever, aching muscles and joints;
- appetite gone, queasiness, sometimes vomiting;
- a dragging or pressing feeling under the right ribs;
- urine as dark as strong tea, and pale stools;
- itchy skin;
- yellowing of the whites of the eyes and then of the skin.
Jaundice looks alarming, but on its own it says nothing about severity: plenty of severe hepatitis runs without it and plenty of mild hepatitis with it.
Chronic inflammation is treacherous precisely because it does not hurt. For years a person feels only tired, or nothing at all, and the problem turns up by chance as raised liver enzymes on a blood test. It is worth seeing a doctor if yellowing, dark urine or stubborn weakness last more than a few days, or if liver readings come back high twice in a row.
Call an ambulance (in Europe, the single number 112) when jaundice comes with confusion, drowsiness and odd behaviour, a flapping tremor with the arms held out, relentless vomiting, vomited blood, black tarry stools or severe abdominal pain. These mean the liver has stopped coping, and there is nothing to wait for.
Hepatitis A and E: what comes in through the mouth
These two viruses have nothing to do with blood and are passed on in food and water. As a rule they leave no chronic form: you have it and that is that.
Hepatitis A lives where water and sewage are poorly kept apart. It is picked up from unwashed greens, ice, tap water while travelling, raw shellfish, and directly from another person by way of unwashed hands. The illness lasts from a few weeks to a couple of months and settles by itself; there is no specific medicine and the symptoms are what get treated. It runs harder in older people and in anyone whose liver is already damaged, where it occasionally reaches liver failure. A reliable vaccine exists and is worth discussing before travelling to places with poor sanitation, and for anyone with chronic liver disease.
Hepatitis E stopped being exotic in Europe long ago and is tied not to travel but to food: undercooked pork, liver and other offal, wild boar and venison, less often shellfish. It usually runs mildly and clears on its own. It is dangerous in two situations: in later pregnancy, where the illness can be severe, and in people with a weakened immune system, after a transplant or on drugs that damp immunity, in whom it can turn chronic. There is no widely available vaccine; thoroughly cooked meat and clean water are the protection.
Hepatitis B and D: through blood and close contact
Hepatitis B spreads through blood, through sex and from mother to baby at birth. The virus is highly infectious and survives well outside the body. What happens next depends heavily on age: an adult more often clears it within a few months, while in babies and small children it almost always becomes chronic. Chronic hepatitis B stays silent for years but leads to cirrhosis and markedly raises the risk of liver cancer — a cancer that sometimes arises even without cirrhosis, which is why monitoring continues however well a person feels.
The virus cannot yet be removed altogether, but antiviral medicines reliably suppress its multiplication and halt the damage. They are taken long term and are not stopped on one's own initiative: an abrupt withdrawal can set off a flare of inflammation.
The main news about hepatitis B is that a vaccine exists and it works. The first doses are given during the first year of life and further doses follow; the exact timing is set out in your country's national schedule and varies from one country to another. Adults in at-risk groups are vaccinated separately: healthcare workers, patients on dialysis, partners of people carrying the virus, and anyone moving for a long stay to a region where the infection is common. Babies born to mothers with hepatitis B have their protection started in the first hours of life.
Hepatitis D cannot live on its own: it needs the coat of the hepatitis B virus, so it occurs only in people who already have hepatitis B. In exchange it is the most aggressive form of viral hepatitis, with cirrhosis arriving sooner and more often. There is no separate vaccine against it, but the hepatitis B vaccine protects here too, and anyone found to have hepatitis B should be checked at least once for this virus as well.
Hepatitis C: quiet but curable
Hepatitis C is passed on through blood: shared needles when injecting drugs, unsterile equipment in a tattoo studio or at the dentist, transfusions from before donated blood was screened. Sexual transmission is uncommon.
It usually causes no symptoms at all, and up to three quarters of those infected live with the virus for years without knowing. That is why a single test is worth doing for anyone who has had even one episode of risk. The diagnosis long ago stopped being frightening: direct-acting antivirals cure more than nine people in ten with a course of tablets lasting two or three months. There is no hepatitis C vaccine, and having had the infection gives no protection against catching it again.
Alcohol-related hepatitis
Alcohol damages the liver directly, and the damage piles up over years without a single complaint. The severe form of alcoholic hepatitis looks quite different: within a few weeks come jaundice, pain under the right ribs, fever and fluid filling the abdomen. This is a life-threatening state and is treated in hospital.
There is no dose of alcohol that is safe for the liver; there are only more and less risky amounts, and less is better. The good news is that at early stages the liver recovers: give up alcohol completely and the inflammation subsides, while scarring that has begun may partly retreat. If stopping on your own does not work, that is a reason to ask a doctor for help rather than a sign of weakness.
When medicines and herbs are to blame
This cause is rarely remembered, yet it is the one most often behind sudden severe liver failure. First place belongs to paracetamol overdose, and usually an accidental one: someone takes several cold remedies at once, each containing paracetamol, or exceeds the dose while barely eating and drinking alcohol.
Ordinary medicines can damage the liver too: certain antibiotics, anti-tuberculosis and antifungal drugs, anti-epileptics, anabolic steroids. A separate and underrated group is herbal preparations and supplements for sport and weight loss. They are assumed to be harmless because they are sold without a prescription, yet a fair number of them are seriously toxic.
The practical conclusion is simple: treat supplements as medicines, do not exceed the dose of fever remedies, and read the ingredients of combined cold products. If nausea, itching, dark urine or jaundice appear after starting something new, the medicine needs discussing with a doctor rather than sitting out.
Autoimmune hepatitis
Sometimes the immune system starts, for reasons still unclear, to treat liver cells as foreign and attack them. This is a rare disease, commoner in women, and it not infrequently keeps company with other autoimmune conditions such as thyroid disease, coeliac disease or rheumatoid arthritis.
It shows itself in different ways: in some, tiredness and joint pain build over months; in others everything starts abruptly with jaundice. The diagnosis rests on a combination of blood tests, specific antibodies and, as a rule, a liver biopsy. It cannot be prevented, but it responds well to treatment: medicines that damp down the immune response settle the inflammation in most people and keep cirrhosis away. Treatment is long, and stopping it unilaterally almost always brings a flare.
How the type of hepatitis is worked out
The starting point is a blood test: liver enzymes show whether there is inflammation, while bilirubin and clotting figures show whether the liver is coping with its work. After that the circle narrows:
- tests for the hepatitis A, B, C and E viruses, and where hepatitis B is found, for D as well;
- a detailed conversation about what you drink, which medicines and supplements you take, where you have been and what you have eaten;
- autoimmune antibodies and blood protein levels;
- an ultrasound scan of the liver and, to gauge scarring, elastography, which measures tissue stiffness without a needle;
- occasionally a biopsy, when the picture stays unclear.
None of this needs ordering in advance: which tests are useful depends on what has actually happened to you, and a doctor picks them with aim.
Online consultation
A remote appointment suits going through a blood test full of baffling numbers and deciding what comes next: liver enzymes turned up at a routine check-up are the commonest reason for that conversation. The doctor will consider whether there was a risk of infection, which investigations make sense in your particular case, whether hepatitis A and B vaccination is needed before a trip or a job, and will help work out whether a rise in the readings has anything to do with a medicine or supplement you are taking. Chronic infection is convenient to follow this way too, discussing repeat tests and the timing of the next review. The signs in the ambulance paragraph are not assessed remotely — with those you call for help at once.
This material is for information only and does not replace medical advice.
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Discuss your symptoms and possible next steps for Hepatitis with a doctor online.
